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4th year gi > Diarrhoea, constipation, gastroenteritis > Flashcards

Diarrhoea, constipation, gastroenteritis Flashcards

1
Q

Definition of diarrhoea

How is diarrhoea divided based on duration?

A

An increase in stool liquidity and/or increase in stool frequency.

<14 days = acute

>4 weeks = chronic

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2
Q

How is constipation commonly described?

When is constipation classed as chronic?

A

It is commonly described as incomplete emptying, excessive straining or reduced stool frequency (<3 times/week).

Constipation persisting >6weeks is termed chronic constipation.

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3
Q

Red flag symptoms for constipation

A
  • Obstructive symptoms
  • Weight loss
  • PR bleeding
  • Recent onset constipation
  • Iron deficiency anaemia
  • Age >50 without any previous cancer screening
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4
Q

Causes of acute diarrhoea

A
  • Infective
    • Gastroenteritis
    • C. diff colitis
  • Drug induced
    • Antibiotics
    • PPIs
    • NSAIDs
    • Digoxin
  • Bloody
    • Dysentry
    • Acute flare of IBD
    • Diverticulitis
    • Ischaemic colitis
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5
Q

Classes of causes of chronic diarrhoea

A
  • Functional (IBS)
  • Inflammatory
    • IBD
    • Chronic mesenteric ischaemia
    • Chronic infection
  • Watery
  • Fatty
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6
Q

Causes of watery diarrhoea

A
  • Osmotic
    • Dietry intolerance eg lactose, gluten
    • Laxative overuse
  • Secretory
    • Bile acid malabsorption
    • Microscopic colitis
    • Hyperthyroidism, hypercalcaemia
    • Colorectal cancer
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7
Q

Causes of fatty diarrhoea

A

Malabsorption disorders, eg SIBO, chronic pancreatitis, Whipple disease

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8
Q

Classes of causes of constipation

A
  • Structural
  • Normal transit
  • Slow transit (motility disorder)
  • Evacuation disorder
  • Secondary constipation (including drugs)
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9
Q

Structural causes of constipation

A
  • Diverticular disease
  • Colorectal cancer
  • Strictures (eg Crohn’s)
  • Extrinsic compression, eg pelvic mass
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10
Q

Normal transit causes of constipation

A
  • Irritable bowel syndrome
  • Psychological - depression, anxiety associated constipation
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11
Q

Slow transit (motility disorder) causes of constipatation

A
  • Post-op ileus
  • Chronic intestinal pseudo-obstruction
  • Hirschprung disease
  • Neuromuscular disorders, eg MS, Parkinson disease, diabetic neuropathy
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12
Q

Evacuation disorder causes of constipation

A
  • Ano-rectal conditions eg rectal prolapse, anal fissure
  • Pelvic floor dysfunction
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13
Q

Causes of secondary constipation

A
  • Low dietary fibre
  • Inadequate hydration
  • Immobility, old age
  • Metabolic - hypothyroidism, hypercalcaemia, uraemia
  • CKD
  • Pregnancy
  • Drugs
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14
Q

Medications which can cause constipation

A
  • Opiates
  • Anticholinergics eg TCA
  • Calcium channel blockers
  • Iron supplements
  • Antidepressants
  • Antacids
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15
Q

What is gastroenteritis?

A

Gastroenteritis is a non-specific term used to characterise symptoms of acute diarrhoea, nausea and vomiting and abdominal pain.

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16
Q

Name some causitive agents of gastroenteritis

A
  • Bacterial
    • Campylobacter jejuni (most common bacteria cause)
    • E. coli O157
    • Salmonella
  • Viral (30-40%)
    • Norovirus
    • Rotavirus
  • Parasties
    • Giardiasis
    • Cryptosporidiosis
17
Q

Campylobacter jejuni source of infection

A
  • Contaminated water
  • Animal droppings
  • Unpasteurised milk
18
Q

Campylobacter jejuni clinical features

A

Fever and dysentry

19
Q

Campylobacter jejuni complications

A
  • Guillain-Barre syndrome (seen in up to 10% of patinets)
  • Reactive arthritis
20
Q

Campylobacter jejuni gastroenteritis management

A
  • Self limiting in the first 7 days
  • More severe forms may respond to erythromycin
21
Q

Salmonella spp. source

A
  • Contaminated water
  • Eggs, poultry, meat
22
Q

Salmonella spp. gastroenteritis clinical features

A
  • Dysentery and vomiting
  • Abdominal pain
  • Low grade fever
23
Q

Salmonella spp. gastroenteritis complications

A

Reactive arthritis

24
Q

Salmonella spp. gastroenteritis management

A
  • Usually self limiting
  • Ciprofloxacin may be used if there is bacteraemia
25
Q

E. coli O157 source

A

Contaminated food products, usually occurs as outbreaks

26
Q

E. coli O157 gastroenteritis clinical features and complication

A

Dysentry and constant abdo pain

Cx: haemolytic uraemic syndrome (HUS)

27
Q

E. coli gastroenteritis management

A
  • Supportive as antibiotic therapy may worsen symptoms
  • Haemodialysis if necessary
28
Q

Source of norovirus and rotavirus

A

Norovirus - common in adults

Rotavirus - common in children

29
Q

Clinical features of norovirus

A
  • Profuse watery diarrhoea, projectile vomiting
  • Colicky abdominal pain
30
Q

Clinical features of rotavirus

A

Watery diarrhoea and vomiting

31
Q

Managment of norovirus and rotavirus

A

Self limiting, contact precaution

32
Q

Giardia lamblia source

A
  • Contaminated water
  • Common in the tropics
33
Q

Giardia lamblia clinical features

A
  • Explosive, offensive diarrhoea and vomiting
  • Abdominal pain and distension
34
Q

Giardia lamblia management

A

Tinidazole stat and metronidazole for 10 days

35
Q

Cryptosporidiosis source

A
  • Only seen in immunocompromised patients
  • Contaminated water
36
Q

Cryptosporidiosis clinical features

A
  • Profuse diarrhoea
  • Intermittent abdominal pain
37
Q

Cryptosporidiosis management

A
  • Usually self limiting
  • If severe, co-trimoxazole for 7 days

4th year gi (15 decks)

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